Effects of obesity and hysterectomy approach on the surgical management of uterine malignancy

The impact of obesity on surgical outcomes in endometrial cancer patients has been well studied; however, the economic burden attributable to obesity in these patients has not yet been reported. In this study, we sought to compare direct hospital costs for obese and non-obese women undergoing surgical treatment of uterine malignancy (UM). The University HealthSystem Consortium database was queried to identify women with a diagnosis of UM, with and without obesity, who underwent open, laparoscopic, or robotic hysterectomy during the study period (2009-2013). Mean direct hospital costs were compared by hysterectomy approach between obese and non-obese cohorts. 25,263 patients were included; 8,407 (33%) were coded as obese. Of hysterectomies performed on obese women, 55% were open, 9% were laparoscopic, and 36% were robotic. Of hysterectomies performed on non-obese women, 52% were open, 15% were laparoscopic, and 33% were robotic. Frequencies of hysterectomy methods were significantly different (P < .0001) between the obese and non-obese cohorts. Mean direct hospital costs were significantly greater for obese compared with non-obese women regardless of hysterectomy approach: open 17% higher ($12,021 v $10,249; P < .0001), robotic 15% higher ($10,180 v $8,868; p < .0001), and laparoscopic 17% higher ($8,532 v $7,290; P < .0001). In both obese and non-obese cohorts, minimally invasive approaches cost less than open surgery (P < .05). Our results demonstrate that obesity is associated with higher costs of surgical treatment of UM. With the advent of novel payment models, including bundled payments, cost control is of major concern. Weight management and minimally invasive surgery warrant consideration as components of strategies for cost-effective management of UM. Additionally, the high rate of open surgeries performed in our study deserves further investigation. Previous data have consistently demonstrated decreased perioperative morbidity using minimally invasive approaches compared with open procedures. We conclude that minimally invasive approaches are uniformly less costly than open surgery and that this finding further supports their use when feasible.